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Digital Home Health Care

We take for granted many of commonly available home testing devices such as pregnancy and drug tests, digital thermometers, kits to monitor blood glucose levels, and portable blood pressure devices.

The next generation of devices will take us one-step closer to patient directed healthcare. The number of home, portable, and wearable smart devices that will interface with smartphone-based Apps and thus physicians and other caregivers is about to explode. Software companies are rushing to develop new apps and devices useful for monitoring a host of physiologic parameters. However, is there a danger we might go too far?

A digital home health care device is being tested that when pressed to the forehead that can measure a person’s heart rate, temperature, blood oxygen levels, respiratory rate, blood pressure, glucose, alcohol, and cholesterol levels, in addition the electrical activity of their heart and their level of emotional stress (reminds me of the tricorder Dr. McCoy used in Star Trek). The data is transmitted to a smart phone App which is easily available to your physician. An iPhone™ based otoscope App allows parents to upload images of their children’s inner ears when they show signs of infection, with the aim of avoiding unnecessary doctor visits. Other smartphone Apps have been developed to help radiologists read medical images and allow patients to track moles for signs of skin cancer.

One start-up company has been working on a device that connects to your iPhone and can identify smells—so you may one day ask “Siri, how does my breath smell?” while breathing into your iPhone. Besides detecting bad breath, future applications of the device may include detecting low blood sugar and high blood alcohol with just an exhale.

The AliveCor Heart Monitor consists of a case that snaps onto the iPhone with electrodes on the back. It reads heart rhythms and relays the recording to an iPhone App. With this ECG data you and your physician can determine whether your heart rhythm is normal or detect an atrial fibrillation (a leading cause of stroke). Results from a study published in the Wall Street Journal reported that the use of Smart phone technologies was associated with a significant reduction in patients’ Framingham risk score, which estimates the 10-year risk of a first heart attack.

How about smart pill bottles that ping you and your doctor to say how much of your prescribed medication remains. These are useful for monitoring when to refill prescription and to determine compliance with medication adherence. Besides smart phone Apps, a rapid at-home inexpensive test for early detection of pancreatic cancer, created by Jack Andrea when he was 15 years old, is in development. The device carbon nanotubes laced with an antibody that reacts to a protein—mesothelin—found in the blood of people with pancreatic cancer. The test uses paper sensor strips that costs 3 cents and are 90% accurate.
Funding from the Bill and Melinda Gates Foundation, has led to the development of a needle-free way to deliver vaccine directly into the skin. The technology consists of a disc-shaped micro needle array—very tiny projections made of sugar mixed with the vaccine. When the disc is pressed against the skin, the micro needles dissolve to deliver the vaccine. For people who do not have easy access to health services or people who continuously need to blood test or have injections for conditions like diabetes, this could be a lifesaver.
There are other devices in development whose usefulness can be debated. A Wellbeing Toilet that can analyze waste to detect disease, nutritional deficiencies, sugar levels, and pregnancy from the comfort of your bathroom may be in your future. It also takes your weight when you sit down. Again, the information can be sent to a smart phone and easily shared with a caregiver. There are smart belts that monitor the balance of the elderly and smart carpets that detect falls. Smart forks are available to inform us we are eating too fast. Smart toothbrushes urge us to spend more time brushing our teeth.

One important issue with all this technology is how long will it be before the self-tracking of our health (weight, diet, step taken in day) graduates from being a recreational novelty to a virtual requirement? Will these devices and Apps move from being optional to being mandatory for insurance or government reasons? The endpoint may not being helping individuals achieve better health behavior but social engineering disguised as product engineering.